Intended for healthcare professionals

Clinical Review ABC of oral health

Oral health care for patients with special needs

BMJ 2000; 321 doi: (Published 19 August 2000) Cite this as: BMJ 2000;321:495
  1. Roger Davies,
  2. Raman Bedi,
  3. Crispian Scully

    People with special needs are those whose dental care is complicated by a physical, mental, or social disability. They have tended to receive less oral health care, or of lower quality, than the general population, yet they may have oral problems that can affect systemic health. Improving oral health for people with special needs is possible mainly through community based dental care systems. Education of patients and parents or carers with regard to prevention and treatment of oral disease must be planned from an early stage. This will minimise disease and operative intervention since extractions and surgical procedures in particular often produce major problems. Dental healthcare workers also often need to be educated about this subject.

    Appalling oral hygiene and periodontitis in a patient awaiting cardiac valvular surgery. Dental procedures involving gingival laceration or periodontal disruption (such as extraction) can produce bacteraemia of oral microorganisms, which could lead to infective endocarditis

    In this context various conditions can lead to people needing special care, not least patients with dental phobias. Many of these patients can be treated with behavioural modification techniques, though a minority will require sedation or general anaesthesia.

    This article concentrates on those who are medically compromised, mentally challenged, mentally ill, or socially excluded.

    Erythematous candidiasis, presenting as a median rhomboid glossitis, is common in patients with immune defects

    Medically compromised patients

    The commonest problems are in patients with a bleeding tendency or cardiovascular disease, or who are immunocompromised.

    Bleeding disorders

    Dental extractions and surgical procedures, including local analgesic injections, can cause problems in patients treated with anticoagulant drugs and those with coagulation defects or severe thrombocytopenic states.

    With patients treated with anticoagulant drugs, local analgesia and minor surgery (simple extractions of two or three teeth) may generally be carried out safely in general practice with no change in treatment if test results are …

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